328 THE EAR
meatus, and even project beyond it (Plate IX, 2). One or more may be seen
and, unless they are very small, they are pear-shaped, being constricted
where they pass through the tympanic membrane. They may be bright red,
but if they are large and if they project from the outer opening of the meatus
they are skin-coloured. The large polypi which are pale and oedematous
usually arise from the tympanic ring, and their removal is free from the
danger of setting up a labyrinthitis, while the red vascular polypi often
arise from the promontory and labyrinthitis may follow their removal.
SYMPTOMS. Granulations and polypi frequently do not produce any symp-
toms apart from those due to the chronic otorrhoea to which they owe
their origin, but in some cases there is a history of bleeding from the ear.
Pain is not a common symptom and occurs only when secretions are dammed
up due to blockage by the polypus. The amount of deafness varies greatly,
and depends upon the size and position of the polypus and upon the destruc-
tion of the tympanic structures caused by the original infection.
DIAGNOSIS. This is usually made without difficulty after any discharge
has been cleared away either by mopping or syringeing. A granulation
appears as a red sessile growth, situated on the medial wall of the middle
ear, or appearing to fill a perforation of the drumhead, or to grow from
the membrane or the posterior meatal wall adjacent to the drum. In the
last situation it may be possible to detect carious bone through the granula-
tions by means of a probe. A polypus is soft and mobile, and does not arise
from the meatal wall but appears to protrude through the drumhead. The
polypus is characteristically pear-shaped and has a long pedicle, and is
pink or red in colour. Because granulations and polypi may arise from the
labyrinthine wall cochlear and vestibular reactions should be tested before
removal is undertaken. Differential diagnosis must be made from a glomus
tumour (p. 382) if a polypus bleeds easily on manipulation. In this event a
biopsy may be taken after preparations have been made to control profuse
TREATMENT. The treatment of granulations and polypi must be combined
with that of the chronic suppuration in the middle ear. When cochlear and
vestibular tests indicate that the labyrinth is involved, no attempt at simple
removal should be made. When there is very little granulation tissue present
treatment may be confined to spirit drops after each syringeing of the ear
to remove discharge. Should this not destroy the granulations, they may
be cauterized by the application of a silver nitrate stick or copper sulphate,
or they may be removed by curettage. The simplest method of removing a
polypus is by means of the aural snare via the meatus (Fig. 169). The snare
is threaded over the polypus and carried medially as far as possible when
the wire is tightened and the polypus removed. After-treatment consists of
syringeing the discharge and the use of spirit drops.
Polypi and granulations tend to recur after removal in the majority of
cases, and such recurrence usually requires mastoid surgery to eradicate
the underlying disease.
Other descriptive titles such as *cholesteatosis% 'epidermosis', 'keratosis'
and 'destructive ear disease' have been applied to this condition, which